What Are Copays?
A copay is the amount of money you may need to pay to get a service. As a Healthy Blue member, you will not have copays for medical services. You also do not have copays for some prescription drugs and over-the-counter medicines. If you cannot pay the copay when you receive care, you will still get the care you need, but you may have to pay the copay later. It will be up to your doctor or other provider to collect the full copay, if a copay applies.
Medical Services
As a member, you do not have copays for any of these services:
Doctor's office, primary care provider (PCP) and specialist visits.
Chiropractor visits.
Medical equipment and supplies (per item).
Home health visits.
Inpatient care given during a hospital stay.
Outpatient care given at a hospital, other than ER visits.
Podiatrist (foot doctor) visits.
Ambulatory surgical center visits.
Federally Qualified Health Center (FQHC) visits.
Rural Health Clinic (RHC) visits.
Pharmacy Services
You will not have to pay a copay for certain medications. This includes drugs in these categories:
Drugs used to help you stop smoking.
Blood thinners.
Antiviral/HIV drugs.
Drugs used to:
Treat diabetes.
Control your cholesterol.
And support heart health, such as drugs to treat high blood pressure or irregular heartbeat.
Birth control.
Narcan for opioid overdose.
You will pay a $3.40 copay for all other generic or brand-name drugs your doctor prescribes. These drugs must be on our Preferred Drug List (PDL).
Dental
S.C. Healthy Connections Medicaid provides your dental benefits through DentaQuest. There is a $3.40 copay for covered dental services.
Other Services
You never have copays for these services:
Orthotic services provided by and medical equipment and supplies given by the Department of Health and Environmental Control (DHEC).
Family planning
Care.
Supplies.
Or Medicine, including contraceptives.
End-stage renal disease care.
Infusion center care.
Preventive care or urgent care visits.
Rehabilitative behavioral health services.
Early and Periodic Screening, Diagnosis and Treatment (EPSDT)/well-child visits or services.
Vaccines.
Counseling through the Tobacco Quitline at 800-QUIT-NOW (800-784-8669).
Hospice benefits.
Waiver services.
Emergency care (ER visits) in the U.S.
Members Who Do Not Have Copays
These members never have to pay any copays, including dental and pharmacy copays:
Children under 19 years of age.
Pregnant women.
Members in institutions like:
Nursing facilities.
Intermediate care facilities for people with intellectual disabilities.
Members of federally recognized American Indian tribes. Tribal members do not pay for services from the Catawba Service Unit in Rock Hill, South Carolina, or when referred to a specialist or other medical provider by the Catawba Service Unit.
If You Get a Bill
Healthy Blue will pay all costs for covered services except for any required copays such as those for prescription drugs or dental services. Most of the time, you should not get a bill from providers in our network.
You may have to pay for charges if:
You agreed ahead of time to pay for services that are not covered or approved by us.
You agreed ahead of time to pay for services from a provider who is not in our plan, and you did not receive our approval ahead of time but asked for the service anyway.
There is a copay for the services you got that you didn’t pay when you received them.
If you get a bill and you do not think you should have to pay for the charges, call Customer Service. Have the bill with you so you can tell us the date of service, the amount charged and why you were billed.
Sometimes a provider may send you a statement that is not a bill. We will tell you if you have to pay it.